Rheumatology

Question 1

Erythrocyte Sedimentation Rate (ESR) measures?

Marker for?

Answer 1

Distance RBC falls in 1 hr

Inflammation (nonspecific) ->
inflamm dzs cause RBCs to settle more quickly

Question 2

C-Reactive Protein (CRP) is?

Tells us?

P marker for?

Answer 2

Protein made by liver during acute inflamm

Inflamm (nonspecific), bacterial inf, tissue necrosis
More sensitive than ESR

CAD (due to inflamm plaques)

Question 3

Antinuclear Antibodies (ANA) + results tells us?

Answer 3

Inflamm (nonspecific)

P SLE, Sjogren, scleroderm, RA, JRA, fibromyal

Question 4

ANA patterns a/w:

Homogenous?

Rim?

Speckled?

Nuclear?

Answer 4

Homogenous: SLE, CT

Rim: SLE

Speckled: many

Nuclear: sclero

Question 5

Antibodies to Double-Stranded DNA (anti-dsDNA) are?

Tells us?

Titers fluctuate?

Answer 5

Anti-nuclear antibodies targeting double stranded DNA antigens

Very specific but not sensitive for SLE
P + result w/ other rheumatoid dzs
Can monitor dz activity

w/ flares

Question 6

Antibodies to Single-Stranded DNA (anti-ssDNA) are?

Tells us?

Answer 6

Anti-nuclear antibodies targeting single stranded DNA antigens

Non-specific for SLE, RA, Drug SLE

Question 7

Antibody to Smith Antigen (anti-Sm) is?

Specific for?

Used for?

Answer 7

Ab against Smith proteins

SLE but only 25% have it

P dx if DNA testing -

Question 8

Anti-phospholipid Antibodies tell us about which antibodies? (2)

Limitations of test?

Why do we care?

Answer 8

Anticardiolipin AB
Lupus Anticoag

+ doesn’t mean SLE

40% of SLE pts have them ->
↑ risk for:
Thrombosis
Spontaneous abortions
Neuropsych disorders
Thrombocytopenia

Question 9

Anit-Histone Antibodies + when?

U induced by? (6)

Answer 9

Drug-induced SLE

Procainamide
Hydralazine
Isoniazid
Methyldopa
Quinidine
Chlorpromazine

Question 10

Rheumatoid Factor (RF) is?

Best used when?

Can also be + with?

Titer NOT useful for?

Answer 10

Ab against IgG -> forms immune complex that targets healthy tissue

Already suspected RA (80% test +)
Many false +

Sjogren, CT, hep, etc

Following dz progression

Question 11

Anticyclic Citrullinated Peptide Antibody (Anti-CCP) is?

Very specific for?

Answer 11

Abs against citrullinated synovial proteins

RA
Rarely + w/ other dz

Question 12

ANA subtype: Anti-SSA/Ro is?

Tells us?

Answer 12

Anti-nuclear Ab

strong a/w primary Sjogrens

Question 13

ANA subtype: Anti-SSB/La is?

Tells us?

Answer 13

Anti-nuclear Ab

strong a/w primary Sjogrens

Question 14

ANA subtype: Anti-SSC is?

Tells us?

Answer 14

Anti-nuclear Ab

a/w Sjogrens 2° to RA

Question 15

Human Leukocyte Antigen B27 (HLA-B27) tells us?

Seen with? (4)

Only helpful when?

Answer 15

Marker for risk of spondylopathies

Ankylosing Spondy (90% +)
Reiter’s (80% +)
Psoriatic arth
IBD arth

Already suspect Anky Spond

Question 16

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Answer 16

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Question 17

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Answer 17

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Question 18

SLE best test?

Results?

Run test when?

Answer 18

Antinuclear Antibodies (ANA)
(95% of SLE will have ANA)

+ w/ staining patterns and titer
Patterns: Homogenous, Rim and Speckled
Titer: Higher = higher likelihood of dz

Only pts meeting ACR criteria

Question 19

SLE most specific test?

Answer 19

anti-dsDNA (97%)

but only 60% of SLE have + test

Question 20

Antiphospholipid Antibody Syndrome triad?

Who gets this?

Eval pts for this when?

Answer 20

thrombosis + miscarriage + thrombocytopenia

NOT just SLE, anyone

Recent unexplained CVA, MI or miscarriage

Question 21

Drug-induced SLE lab tests?

Answer 21

Anti-histone Ab = +
Anti-dsDNA = -
Anti-Sm Ab = -

Question 22

Signs of RA? (3)

Answer 22

Boutonniere (ext DIP, flex PIP)
Swan neck (flex DIP, ext PIP)
Ulnar deviation (MCP)

Question 23

RA lab tests? (4)

Answer 23

RF = + or -
Anti-CCP = + (VERY SPECIFIC)
ESR = ↑
CRP = ↑

Question 24

Sjogren’s Synd is?

a/w?

Causes?

Answer 24

Autoimm dz of exocrine glands

other rheum dzs (RA)

Dry eyes/muc mem
“Keratoconjunctivitis sicca”

Question 25

Keratoconjunctivitis sicca is?

Answer 25

a/w Sjogren’s

lymphocyte and plasma cell infiltration of lacrimal glands

Question 26

Sjogren’s Synd lab tests? (7)

Answer 26

CBC = mild anemia, leukopenia, eosinophilia
RF = + or -
anti-SSA/SSB = +
Electrophoresis = polyclonal hypergammaglobulinemia (over cloning of gamma)
Schirmer test = for tears
Lip bx
Salavary gland bx (if atypical presentation)

Question 27

Polymyalgia Rheumatica (PMR) is?

Presentation?

Lab test?

Answer 27

Rheum inflamm dz U involving neck/torso, shoulders/prox arms, hips/prox thighs

> 50yo
Bilat aching/stiff in a.m. in 2 of 3 above
a/w Temporal Arteritis

ESR > 40

Question 28

Ankylosing Spondylitis is?

Lab test?

Answer 28

Inflammatory disease causing fusion of vertebrae

HLA-B27 (90% +)